Oakland Tribune editorial: No one recovers from being brain dead

Oakland Tribune editorial

Posted:
12/27/2013 01:00:00 PM PST

Every parent identifies with Nailah Winkfield's desperate search for a miracle for her 13-year-old daughter, Jahi McMath, who was declared brain dead after a tonsillectomy that went horribly wrong Dec. 9. The family's pain has been all the more heart-wrenching as the tragedy unfolded over Christmas, the season of hope for so many.

It also is an impossible situation for Oakland Children's Hospital and the doctors involved.

Last week a Lucille Packard Children's Hospital neurosurgeon appointed by a judge as an independent expert was the latest to certify that Jahi is brain dead.

Nailah Winkfield reacts during a press conference organized by local clergy regarding her daughter, 13-year-old patient Jahi McMath, outside Children's Hospital Oakland on Sunday, Dec. 22, 2013, in Oakland, Calif. McMath, who doctors declared brain dead after complications from a tonsillectomy, is being kept on life support until a court-appointed doctor can examine her. (D. Ross Cameron/Bay Area News Group)

People do come out of comas and, on occasion, out of a persistent vegetative state. It can seem truly like a miracle. But in these states, the brain still has some functions. There is no recovery from brain death. Ever. It is a uniform standard for being legally dead in California and nearly every other state.

Machines that keep lungs and hearts pumping give loved ones the illusion of life. But it is an illusion. And the cost to society, hospitals and caregivers to maintain a fiction of hope is simply too high.

Keeping a patient on life support in an intensive care unit costs, at a minimum, $2,000-$4,000 per day and can run to hundreds of thousands in a year. Nurses and doctors have to provide continuous care, warding off bed sores and other problems. It takes time and equipment capacity that otherwise could be available to ICU patients who have real hope of recovery.

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The family's decision Thursday to move Jahi to a care facility raised further ethical issues for Children's Hospital, which would need to perform surgical procedures on a person who is legally dead.

Since the beginning of civilization, doctors and religious leaders have struggled to define when a person is dead. The ancient Egyptians focused on the beating of the heart. Others over the centuries looked at breathing or a response to stimulation.

In 1968, a Harvard Medical School committee developed a new definition of death as the moment when a person suffered irreversible cessation of the functions of the entire brain, including the brainstem. The theory was that a person's consciousness, or being, was dependent on brain function.

Doctors have been refining the test for brain death ever since. But brain activity, once fully ended, does not return.

The tragedy of Jahi McMath shows that many people are still uncomfortable with equating the death of the brain with death itself, when machines keep lungs and hearts going. But as widely respected medical ethicist Arthur Caplan wrote last week, "Once brain death is declared, doctors have the right to stop treatments including life-support. ... no matter what the family might say, death is a clear line beyond which treatment need not and should not continue."

Jahi's tragedy has touched the hearts of millions. We wish her family the strength and grace to cope with it.